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Pharm 1 > Pharm 1 final exam SG Peer Completed > Flashcards

Pharm 1 final exam SG Peer Completed Flashcards

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1
Q

What are the adverse effects and drug toxicity do in older adults?

A

Polypharmacy - Greater risk for medication errors (forgetting to take/taking too many times)

Drug polymorphism - use of multiple drugs to treat a single or multiple diseases.

the pharmacokinetics of specific drugs

Absorption slowed
Distribution decreased
Metabolism decreased
Excretion decreased

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2
Q

how medications/drugs are dosed for neonates and pediatrics?

A

mg/kg

2.2lb = 1kg

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3
Q

What is HIPAA and examples of violations in relations to pharmacology?

A

Privacy and Confidentiality

e.g. Don’t share prescription information with parties not approved by the client

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4
Q

What is a black box warning is and what it means to those that are prescribed a med with a black box warning?

A

Strictest FDA Warning

Indicates serious adverse effects

i.e. injury, serious illness or death

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5
Q

What are the 3 classes of FDA recall?

A

Class I: Most serious type. When a medication is removed from the market because there is a reasonable probability of serious adverse health problems or death.

Class II: Less severe. A medication is removed from the market because it may result in temporary or medically reversible health effects.

Class III: Least severe and is not likely to result in any significant health problems.

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6
Q

What is the rule regarding leading and trailing zeros?

A

No trailing zeros!! (Do not use 5.0 mg; use 5 mg instead)

ALWAYS use leading zeros!! (Do not use .25 mg; use 0.25 mg instead)

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7
Q

What are the ways to prevent medication errors

A 
KEY TO PREVENTION = REPORTING THE ERROR!
Checks and balances 
9 rights of medication administration
2 patient identifiers
Check drug references/pharmacist
Check every medication 3 times, twice on the MAR
Do not administer if you did NOT draw up or prepare yourself
Avoid abbreviations
Use generic names 
Check patient allergies
Never assume anything
Avoid verbal orders
Cross-check dosage with another nurse for high-risk medication
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8
Q

10 rights of medication administration

A
  1. Drug
  2. Dose
  3. Time
  4. Route/form
  5. Patient
  6. Documentation
  7. Client education
  8. To refuse
  9. Assessment
  10. Evaluation

Did Doug Take Ray Past Dark?
Can’t Tell Aunt Ellie!

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9
Q

What is the patient education for the use of baclofen (Lioresal)?

A

*SAFETY:
Do NOT stop abruptly (Black Box) - Rebound Spasticity
Dizziness - Fall Risk (CNS Depressant)
no driving
Take w/milk or food if GI upset
Monitor LoC
First dose tests for reaction - given intrathecally

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10
Q

At what stage in a patient’s hospitalization does discharge teaching begin?

A

Upon admission

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11
Q

What is the priority nursing interventions with propofol (Dipravan) in the peri-operative period?

A

Patient education: Pain/Burning on injection, can cause green urine
Patient must be ventilated!
Monitor blood pressure (Hypotension)
Monitor Respiratory Rate (respiratory depression)

Note: works for people with kidney and liver disease where other anesthetics might not

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12
Q

What is the contraindications of baclofen (Lioresal)?

A

Contraindication: Renal impairment

Watch for nephrotoxicity - BUN, creatinine, inputs/outputs

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13
Q

What is amphetamine (adderall) contraindications?

A

Severe, uncontrolled HTN

Glaucoma

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14
Q

What is amphetamine (adderall) adverse effects?

A

*speeds up everything!
Tachycardia, HTN, anxiety, insomnia, tremors, dry mouth, loss of appetite, weight loss, dysrhythmias at a toxic level

Weight loss in children

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15
Q

What is amphetamine (adderall) patient education?

A

avoid caffeine
Monitor weight and appetite of children
Drug holiday (e.g. don’t take on weekends to avoid tolerance buildup)
Don’t take past 4 pm, can cause insomnia

Black box warning - high potential for abuse
Taper off, do not stop abruptly

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16
Q

What is the MOA of carbidopa/levodopa?

A

MOA: carbidopa inhibits decarboxylase → lets levodopa get to the brain

Carbidopa protects levodopa, allowing it to get across blood/brain barrier, allowing levodopa to convert into dopamine

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17
Q

What is carbidopa/levodopa patient education?

A

may take up to 6 months to see results
Very important to take it at the same time every day
best to take on empty stomach
avoid high protein diet
Vitamin B6 reduces the effectiveness
On-Off and Wearing-off phenomenons
Orthostatic hypotension
Dyskinesia
Can cause darkened sweat/urine
Constipation is a big issue (hydration & stool softeners)
Watch for changes in moles/skin spots (can activate malignant melanoma)

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18
Q

What is opioid contraindications?

A

Pregnancy
Renal failure
Respiratory insufficiency
Gallbladder

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19
Q

What is the adverse effects of opioid?

A 
Respiratory depression 
Sedation
Dizziness
Urinary Retention
Constipation 
Nausea
Pruritus

Black Box Warning - Highly Addictive and Highly Toxic
Neonatal withdrawal symptom
Extreme resp. dep. when taken with Benzos

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20
Q

What is the nursing interventions of opioid?

A

Monitor - respiratory status (airway)

Antidote: naloxone (Narcan)
Acts almost immediately but wears off before opioids leave the system, so have additional doses available
Nasal at home, IV/IM in hospital
After administering for respiratory depression (e.g. post-surgery), pt. will need a new form of analgesic

If the patient is <8 respirations/min first action is to ASSESS
e.g. pt. might be asleep, monitor might not be working etc.

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21
Q

What is the contraindications of acetaminophen?

A

Liver disease
Careful with children
Alcohol

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22
Q

What is the adverse effects of acetaminophen?

A

Hepatotoxicity
Hypertension
Toxicity symptoms - N/V/D, abd discomfort, sweating

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23
Q

What is the proper dosing of acetaminophen?

A

FDA - 4000mg in 24hr
Tylenol - 3000mg in 24hr
Hospital recommendation 3500mg in 24 hr

*Patients with liver disease/or alcohol abuse - 2000mg in 24 hours

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24
Q

What are the adverse effects of Glucocorticoid?

A 
Moon Face (Cushing-like effects)
Truncal Obesity 
Hyperglycemia
Psychosis
Adrenal Suppression
Decreased Bone Density
Gastrointestinal Distress
Risk of ulcers
Decreased Immune Function
Increased Intraocular Pressure
Linked to Cataracts
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25
What is the nursing interventions of glucocorticoid?
``` Monitor: blood glucose Physical/Emotional Stress GI Bleeding Infections T-Score for bone density ``` Education: Bone weakness possible Tapering off slowly - If not can cause adrenal crisis Adrenal glands are suppressed when taking, need to be ramped back up
26
What is the indication for use of over the counter medications?
Customer must be able to easily: Diagnose condition montior effectivness benefits of correct usage must outweigh risks
27
What is safety profile of over the counter medications?
drug must have: favorable adverse event profile Limited interaction with other drugs Low potential for abuse High therapeutic index
28
What is the practicality of over the counter use?
Drugs must be: | Easy to use and monitor
29
The use of over the counter medications?
Can still interact Can still be dangerous Can delay appropriate diagnosis
30
safety considerations for the use of herbal supplements
Not FDA Regulated Can have drug interactions - St. John’s Wort interacts with anything Serotonin-related Kava potential liver toxicity (acetaminophen), Ephedra (CV & stroke risk), herbal supplements should be avoided by clients with CV diseases Ginko, Garlic, Ginger can increase bleed risk May not be safe for pregnant women, infants or children Natural does not mean safe Educate patient to monitor for reactions
31
Describe the role of the nurse in caring for clients with gene therapy and pharmacogenomics?
Patient education on risk of therapy not working - Adverse effects if wrong gene is activated Different people react differently based on genetic makeup - This difference can not be predicted Nurse acts as advocate for patients going through these therapies - report how drugs are affecting their clients Nurses should stay up to date on new therapies to accurately monitor for side effects. Some gene therapies can be passed on to future generations depending on if those genes are passed through sperm/egg Germline passes to next gen Somatic does not pass to next gen
32
Describe how pharmacogenomics and gene therapy can impact prescribing and dosing medications?
Helps to predict patient responses to certain drugs based on their genetic makeup Can determine dosing based on client’s metabolism Can help predict adverse effects / interactions between drugs in a client
33
patient teaching related to the use of selective serotonin reuptake inhibitors (SSRIs) - fluoxetine (Prozac)
Takes time to reach therapeutic levels Serotonin Syndrome - Interacts with St. John’s Wort, MAOIs etc. to raise Serotonin to dangerous levels Neuromuscular excitation = tremors, hyperreflexia HTN, tachycardia, fever, sweating, flushed, ha Altered mental state = confusion ``` Taper off - Antidepressant Discontinuation Syndrome Dizziness HA/N/V Aggression Mood disturbances Suicidal tendencies ```
34
patient teaching of AE/SE related to the use of selective serotonin reuptake inhibitors (SSRIs)
``` GI Upset Sexual Dysfunction CNS Stimulation Risk of suicidal ideation esp. when starting Weight gain ```
35
What is the nursing interventions of benzodiazepines - PAM & LAM
Antidote: flumazenil (Romazicon) ``` Monitor ABCs Cardiovascular Depression Dizziness, drowsiness, fatigue, weakness Fall Risk ``` *PRN - no schedule
36
What is the patient teaching of benzodiazepines - Alprazolam (Xanax) - Diazepam (Valium)
Must be in writing due to amnesic effect Coughing and Deep Breathing
37
What is the nursing interventions of atypical antidepressants - bupropion (Wellbutrin)?
``` Monitor: Dizziness Tachycardia Agitation Seizure indications ``` Seizure precautions when staying in hospital Low bed Floor mats Rails up
38
What is the patient teaching of atypical antidepressants - bupropion (Wellbutrin)?
*Contraindicated for patients with history of seizure *Lowers seizure threshold Takes 4-6 weeks to reach max clinical effectiveness Black Box - Risk for suicide up to age 24 Taper off Works best when paired with therapy Also indicated for smoking cessation
39
What is the adverse effects / Complications of conventional antipsychotic medications haloperidol (Haldol) and chlorpromazine (Thorazine)?
Does not effectively treat negative symptoms - apathy, loss of joy, withdrawal EPS - Extra Pyramidial Syndrome Akathisia (painful muscle restlessness) Acute dystonia (painful muscle spasms) Tardive dyskinesia (lip smacking, tongue thrusting) NMS - Neuroleptic Malignant Syndrome (can happen after 1st dose or after 20 years) High fever Unstable BP rare but life threatening Anticholergenic effects Cardiac dysrhythmias EPS/NMS can stay after stopping drug
40
What is the nursing interventions of tricyclic antidepressants amitriptyline (Elavil)?
* overdose is very LETHAL * don’t give a full month’s dose toxicity: seizures & cardiac dysrhythmias
41
What is the patient teaching of tricyclic antidepressants amitriptyline (Elavil)?
interacts with MAOI’s 4-6 wks for full effect LETHAL overdose
42
Correct eye drop administration techniques
1. wash hands 2. apply gloves 3. pull eyelid down 4. put drop in bottom eyelid 5. pt applies pressure to inner canthus (esp. beta blockers) for 60 sec
43
Common adverse effects of all ophthalmic medications
``` Blurred Vision Myopia Discomfort Photophobia Adverse Effects local and limited to the eye ```
44
Nursing assessment and interventions for clients with renal and hepatic dysfunction
Renal: BUN, Creatinine, Inputs/Outputs Hepatic: Jaundice LFTs: increased AST/ALT enzymes abdominal pain where liver is N/V
45
What is the adverse drug reaction of pharmacologic?
Therapeutic effect too extreme e.g. Antihypertensive drug lowering blood pressure too much
46
What is the adverse drug reaction of idiosyncratic? *
ABNORMAL/UNEXPECTED response, often due to genetics ex: hyperactivity with Benadryl
47
What is the adverse drug of allergic reaction?
(hypersensitivity) Involves immune response hives, wheezing, itching, swelling
48
What is medication error?
PREVENTABLE adverse drug event by patient or hc provider | may or may not cause harm
49
What is Synergistic Reaction?
More of an effect together than they would individually 1+1=3 e.g. Tylenol & Ibuprofen
50
Differentiate between objective and subjective assessment data
Objective is measurable or observable Subjective is what the patient tells you
51
What is the nursing interventions to the use of acyclovir (Zovirax)?
Topical - Wear Gloves Can cause Burning, Headache, Nausea/Diarrhea PO - risk of n/v/d IV - risk of nephrotoxicity * Monitoring BUN, Creatinine, I/O
52
What is the patient teaching to the use of acyclovir (Zovirax)?
Avoid sexual intercourse with active lesions | Use condoms with inactive lesions - Can still spread even without active lesions
53
Patient teaching related to the principles of antiviral therapy
Treats symptoms and can speed up remission but does not cure Not for use with immunocompromised clients
54
What is the adverse effects of amphotericin B (Fungizone) and how to prevent and mange them?
Pretreate with tylenol, antihistamine, antiemetics Can be very hard on veins - Use a large vein - Ensure patency before admin If there is an infusion reaction slow the infusion Monitor for nephrotoxicity BUN, Creatinine, I/O ``` SE/AE ○ fever/chills ○ nausea ○ hypotension ○ tachycardia ```
55
What are the adverse effects of anti-tubercular - rifampin (Rifadin) & isoniazid (INH)?
isoniazid (INH) DRESS - Drug reaction with Eosinophilia and systemic systems Fever, Rash, Facial Edema, Lymphadenopathy Causes B6 deficiency - can lead to peripheral neuropathy rifampin (Rifadin) orange/brown bodily fluids Expected.
56
What is the interaction of anti-tubercular - rifampin (Rifadin) & isoniazid (INH)?
Monitor hepatotoxicity | Jaundice, AST/ALT (LFTs)
57
What is the patient teaching of anti-tubercular - rifampin (Rifadin) & isoniazid (INH)?
Must finish all of a very long (6 month) treatment Reduces effectiveness of oral contraceptives
58
What are the adverse effects of gentamicin?
Nephrotoxicity | Ototoxicity
59
What is the nursing assessment of gentamicin?
Monitor for tinnitus Monitor Kidneys Given IV - can be yellowish but should never be cloudy
60
What are the interventions for client who takes gentamicin?
``` Monitor trough level 1mcg/mL = therapeutic level 2+ toxic Take with food Do not share IV lumen with other drugs ```
61
What are the interventions of vancomycin (Vancocin)?
Trough level 15-20 mcg/mL *Monitor for Ototoxicity - Tinnitus *Monitor for Nephrotoxicity BUN, Creatinine, I/O
62
What is the patient teaching for vancomycin (Vancocin)?
Red Man’s Syn. = flush face/ trunk, itchy, hives take w food labs drawn regularly
63
What are the interactions to the use of metronidazole (Flagyl)?
*Alcohol & Lithium - Extreme vomiting interaction with alcohol Can even interact with hand sanitizers/mouthwash etc. *Needs its own IV line Monitor for dizziness, Headache, seizures*
64
What is the patient teach to the use of metronidazole (Flagyl)?
No alcohol | Take with food
65
Patient teaching related to the use of metoprolol (Lopressor)
How to take own pulse/blood pressure - Hold if HR < 60 Do not stop abruptly - Can cause hypertensive crisis For diabetics - Take blood glucose regularly - Can mask symptoms of hypoglycemia Know signs of heart failure Orthostatic Hypotension Take with food
66
What are the medication interactions to the use of captopril (Capoten)?
Aliskiren- risk of hypotn, hyperk, renal issues, Antacids- decrease affect ARBs- increase toxicity Lithium- increase lithium levels NSAIDs- decrease effects K+ sparing diuretics, salt substitutes w/ K+ = hyperkalemia
67
What is the patient teaching to the use of captopril (Capoten)?
Dry, non-productive cough first dose effect - hypotension Keep blood pressure log Watch for too much potassium in diet
68
What are the interventions to the use of valproic acid (Depakote)?
Monitor therapeutic range - 50-125mcg/mL ``` Monitor: Pancreatitis - Abd. Pain, N/V, anorexia Blood Dyscrasia / Bone Marrow Suppression - Watch for infections Labs - CBC, Platelet, Liver, Renal worsening depression/suicidal ideation ```
69
What is the patient teaching to the use of valproic acid (Depakote)?
Seizure Medication Education No alcohol No oral contraceptives
70
Toxicity and patient response to medication related to the use of phenytoin (Dilantin)
Therapeutic range = 10-20mcg/mL Infuse through IV slow (toxicity with a fast infusion), put patient on tele Sleepiness can be sign of drug toxicity or nystagmus (rapid involuntary eye movements) Cardiac issues - Dysrhythmias increases CNS effects avoid alcohol & Tylenol - risk of toxicity
71
Prioritization interventions related to carbamazepine (Tegretol)
Contraindicated in pregnant women Pt edu: ↓ OC effect pill coating can show up in stool take w. food pills sensitive to moisture - store in dry place bone marrow suppression → report signs of infx - fever, sore throat, chills
72
What are the adverse effects related to carbamazepine (Tegretol)
Therapeutic range 4-12mcg/mL hepatic/renal impairment ✓ LFTs, jaundice, abd pain, N/V ✓ BUN, creatinine, I&O’s Anorexia = toxicity (draw blood to monitor) blood dyscrasias = ↓ levels
73
Patient education related to adverse effects and interactions with donepezil (Aricept)
Take at bedtime due to drowsiness Monitor for Bradycardia - Contact provider if < 60 Monitor for GI bleeds (tarry stools, blood in stool, coffee ground emesis) No NSAIDS as those can cause bleeds Anemia can be from GI bleeds Take at regular intervals
74
Medication interactions related to sumatriptan (Imitrex)
Drugs that ↑ Serotonin = SSRIs, MAOIs, St. John’s Wort (antidepressants) - Can cause serotonin syndrome Neuromuscular excitation: tremors, hyperreflexia Autonomic Nervous System dysfunction: ↑ BP, ↑ HR, fever, flushing, HA Altered Mental Status: ↑ confusion Vasoconstrictor - can increase risk of MI, Stroke, Coronary Artery Disease, Peripheral Artery Disease - Bad for ischemic conditions
75
patient teaching related to sumatriptan (Imitrex)
● OTC & supplements can interact | ● med works BEST in AURA phase

Pharm 1 (1 decks)

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